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Is it harder for everyone getting healthcare?


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Full disclosure before you start reading this. I am a Healthcare Professional and have been a Registered Nurse since 1989. I was an ambulance driver, EMT-A, EMT-1 and an EMT- Paramedic starting in 1976, so I have been involved in healthcare for a long time. 

Fortunately for me, I have had very few instances where I was required to seek professional assistance. Sure back in the day there were the "sidewalk" consultations and I once was given "Professional Courtesy discount" for the care of a foot fracture. Those days are long over. 

As I have aged I have had a couple times when my blood pressure registered a bit higher than I liked and then it became more consistently elevated I have a friend who was a Cardiologist who has changed to a Primary Care Provider (PCP) and agreed to treat my BP from a distance. I would just have to visit every couple of years on my way through town. I thought all was good, until I started my most recent assignment. 

I worked at the facility in 2018 and at the end of my assignment I was forced to receive an immunization so I would be able to start at my next location. Immediately following the administration I developed a rash and reported it to everyone who was involved and can now say without question I am allergic to that form of immunization. I did not require at that time an intervention by a licensed medical provider. My symptoms resolved as soon as I left the area. 

Fast forward to 2021. I have returned to the location again and almost as soon as I started working the sensation of the rash returned. I have tried all the things I did with the prior reaction (except leaving the area) and so far have only had worsening of the symptoms. I reached out to my Employer and their suggestion was to seek evaluation from my PCP. I made the call, but the receptionist said since I was not in the same state as the office a "Zoom" evaluation could not take place. I'm not sure I understand. I have friends who have utilized distant evaluation of a myriad of pediatric concerns for their children in multiple locations. I believe they have "signed up" with a specific provider network or something of the sort, but am not sure. I will reach out to them also, but am asking for other suggestions or stories of issues if anyone else has run into this. I know there have been questions on the Forum regarding "Controlled medications" or pain meds. I am do not need or desire comments on those issues. 

 

Thanks for reading. 

 

Rod

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Have you seen a dermatologist that is in that area?  That is the most logical way to treat it.  BTW - since the rash returned when you returned to the area, clearly it was not the immunization that cause the rash but rather the environmental conditions.  A little detective work on your part seems to be in order.  It can be as simple as the humidity (too wet or too dry), local pollen, hardness of the water, water source, local ingredients in common foods that normally don't bother you, etc.   And you already know the easiest solution - just don't take an assignment in that area.      Have you actually seen the rash appear, or is it just a 'tingling' in the same general skin area?  Again, a local dermatologist would seem like the logical place to start.

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4 minutes ago, Barbaraok said:

Have you seen a dermatologist that is in that area?  That is the most logical way to treat it.  BTW - since the rash returned when you returned to the area, clearly it was not the immunization that cause the rash but rather the environmental conditions.  A little detective work on your part seems to be in order.  It can be as simple as the humidity (too wet or too dry), local pollen, hardness of the water, water source, local ingredients in common foods that normally don't bother you, etc.   And you already know the easiest solution - just don't take an assignment in that area.      Have you actually seen the rash appear, or is it just a 'tingling' in the same general skin area?  Again, a local dermatologist would seem like the logical place to start.

Thank you for your reply. No I did not seek attention from a medical provider in the area when it occurred. I had been here working for almost 13 weeks when I was required to have the immunization. Before that I had no issues and have had no issues since. I agree, there is most likely a contributing factor at my current location, but I also strongly believe it was triggered by the immunization. I have involved my detective side and have attempted elimination techniques including cessation of the use of the provided soaps and cleaners for my hands. I do not wish to continue to supply my own personal cleansers when it's work required . I'm taking you haven't had any issues as a full time traveler with maintaining healthcare. 

Rod 

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I just completed an in person visit with my VA primary care doctor for routine checkup that included labs at main VA hospital campus.  Also have AARP Medicare supplemental that also use for travel everywhere plus any VA med facilities along my route of travel (if needed).

Both private hospital and VA contact me for in person health care exams/checkups such as VA dental work next week.  VA dentist wears both a mask and faceplate.  Good for her and me. 

Many years ago in SE Asia I developed a stubborn rash that would not go away after playing tennis in the heat of day.  Pink spots all over me. Local doctor prescribed a cream and rash eventually disappeared.  Other rashes have come and gone since then.  Best of luck to you and I'm checking out for now.

P.S. NYT  and post news articles. As of 39 minutes ago CDC corrected their director and now says some vaccinated people can still carry the virus.

https://www.facebook.com/william.perkins.79274

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Edited by NamMedevac 70
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1 hour ago, lappir said:

Thank you for your reply. No I did not seek attention from a medical provider in the area when it occurred. I had been here working for almost 13 weeks when I was required to have the immunization. Before that I had no issues and have had no issues since. I agree, there is most likely a contributing factor at my current location, but I also strongly believe it was triggered by the immunization. I have involved my detective side and have attempted elimination techniques including cessation of the use of the provided soaps and cleaners for my hands. I do not wish to continue to supply my own personal cleansers when it's work required . I'm taking you haven't had any issues as a full time traveler with maintaining healthcare. 

Rod 

We’re on Medicare, so no problems.   The first year out, when on insurance from our former employer (part of retirement package), I developed a rash when out in the desert in the spring geocaching.   Put hydrocortisone on it, helped, and then we left area and it subsided.  Would reoccur at times, but hydrocortisone kept it at bay.  When we did or annual physicals I mentioned it to my internist.  He looked at it, as it was itching again, said to try Triamcinolone ointment, and it worked.   Through the years it has become less of a problem in the desert areas,, but always returns about this time of year.  Now just a little hydrocortisone creme does the job and I know that once we get to the coast I won’t have problems. Drug is also used to treat Psoriasis, especially when very mild, which can be triggered by any number of things.

 

 

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2 hours ago, lappir said:

Fast forward to 2021. I have returned to the location again and almost as soon as I started working the sensation of the rash returned.

Am I correct to understand that this time there was no vaccination involved to trigger the reaction, but that it seems to have returned due to your location? Ifso it does make me wonder why you continue to feel that it was initially caused by the vaccination? 

It crosses my mind the possibility of Psoriasis, as Barb suggests. I have experienced a little of that issue also. I am thinking that you are probably younger than either Barb or myself (78) since you are still employed, but I'm not sure that age even plays any part. Like Barb, we have never experienced problems in getting medical attention while traveling, but it has been a couple of years since we last had reason to visit a doctor in an area that we were completely new to. 

2 hours ago, lappir said:

I made the call, but the receptionist said since I was not in the same state as the office a "Zoom" evaluation could not take place.

I believe that your experience warrants some of us to look into this issue more closely but in the past we have generally just gone to one of the walk-in clinics for needed medical care when traveling. Even while we had no home-base we continued to return to the same doctor for our annual checkups and renewal of maintenance medication prescriptions. That may have been a contributing factor. Now that we are back to part-time, we have a continuing relationship with a local primary care physician but since our move to that physician we have not had a reason to contact her while traveling. That did happen on several occasions when we were fulltime, but never recently, so things may be different.

Thank you for bringing up this subject as it may well be that something has changed and so could be important to many here as we begin to travel more with things opening up again.

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I also don't believe it was from the initial vaccination but just a coincidence of timing when the rash first appeared.  You need to see a dermatologist.  We traveled as full-timers and never had an issue with using a particular doctor in another state whom we saw previously to call and ask questions or to get a prescription.  Perhaps with the new Zoom doctoring there are now different regulations.  As we age rashes are common. Our skin is dryer, thinner and more fragile.  See a dermatologist.

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I agree that correlation does not mean causation but, apparently, there is something in that location to which you react. My primary physician said it didn't make a difference if my condition was psoriasis or eczema since they prescribe the same treatment for both. Later when I saw a dermatologist for something else, she said the same thing and prescribed the same medicine. So, I'd just go to a walk-in clinic and see what they say.

Linda Sand

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There have been indications that stress can be an initiator for shingles, psoriasis, and other immune system related skin conditions. I don't know if that's a factor here of course, but it is a possibility worth considering. 

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We migrate north in the spring and south in the fall.  This year the travel portions will take a bit over 20 weeks.  My PCP is in FL where we winter.  Like you, I tried to do a tele medicine visit with my PCP from another state and was told that they will only consult with me if I am in-state.  They said it was licensing/insurance issues.  I am not VA eligible so that wouldn't help.  Back in my old home state (where we spend two months each year) my old PCP is not available and primary care docs are not establishing relationships with out-of-state clients.  I've been relegated to walk-in care for acute conditions, and for chronic ones I have exams before leaving FL and after returning. 

For a skin condition it may depend upon the state you are in to determine whether you need a referral.  I was surprised to learn that dermatologists in FL do not require (and ordinarily don't get) referrals.  When I had a skin condition my PCP told me to find a dermatologist.  I a called dermatologist and had an appointment the next day.  I am not sure where you are, but that may be an option.

Wayne & Jinx
2017 F-350 diesel, dually
2006 Carriage Carri-Lite 36KSQ

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I love hydrocortisone and Neosporin.  Both have saved the day for me many times over the years on holidays and remote camping, fishing and hiking adventures.

For me they work fast within a few days or hours.  Cheers and checking out now.

https://photos.google.com/photo/AF1QipMrizp_KeKkbM7x8OLx6wi-K-XB9fcDPbwmLHwM

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https://pin.it/5Oa2KKJ

 

Edited by NamMedevac 70
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On 4/3/2021 at 7:34 AM, Dutch_12078 said:

There have been indications that stress can be an initiator for shingles, psoriasis, and other immune system related skin conditions.

That has been related to me by people that were told this by their Dr's.  One person said that it can cause flare ups of herpes they were told by their Dr.

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9 hours ago, bigjim said:

That has been related to me by people that were told this by their Dr's.  One person said that it can cause flare ups of herpes they were told by their Dr.

Yes, my dermatologist mentioned it when I was being treated for psoriasis years ago. I didn't give it much credence at the time, but when the psoriasis completely disappeared within a year of retiring, I had to rethink that.

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Here is a little update. Not looking for treatment or care instructions, just sharing the full time issues with Health Care and maybe venting a bit. 

I thought things were getting better. I was able to sleep through the night without waking up with severe itching and doing my best to not scratch. The "Benadryl" ointment (generic kind) worked for a couple applications and then pretty much stopped helping. The application sort of interfered with the if you stop scratching (or rubbing) it will stop itching. (The more you scratch the more you itch) has been my mantra for years. A person can only actively control one aspect. 

To continue. Wednesday I brought my own soap to work and wore white cotton glove liners. I had found some gloves at the local Harbor Freight, don't like buying things there but no where else had any that I could find locally. I had used the gloves Tuesday and things seemed to be much better.  Wednesday I started washing again with my soap and water and by 4pm my hands were red swollen and extremely itchy. They just worsened overnight and by the time I got to work Thursday morning I reported to the person in charge I could not take care of patients until I have been evaluated. A visit to the local employee health turned into a trip to a hospital clinic and a couple prescriptions. I attempted to return to work with the restriction of no direct patient care and was told to go home and get better. Not knowing how long it will take to get better I have inquired about a Workers Compensation filing and am in the process. I have messaged my PCP through my "Patient Portal" but have yet to get a response. I will continue to give updates so I can at least have the information there should they need it in the future. I will be investigating a truly remote health care provider if one can really exist. I don't wish to have a physician in each state I travel to or through and at this point I have no idea if or when I may retire or stop working and where. My standard answer is where ever I'm parked when I can no longer get up to go to work is where I will stay. When people ask me with all my travels where my favorite place is (or was ) I always answer "Right here where I am." If not I wouldn't still be here. 

 

 

Rod

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50 minutes ago, lappir said:

Not looking for treatment or care instructions, just sharing the full time issues with Health Care and maybe venting a bit. 

It certainly seems to me that you have earned the right to vent a little, or maybe even a lot. With my only medical background being first aid and CPR courses and patient experiences, there isn't anything that I could suggest which you don't already know. I wish that I could offer more but at least I am listening and have empathy!

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21 minutes ago, Kirk W said:

It certainly seems to me that you have earned the right to vent a little, or maybe even a lot. With my only medical background being first aid and CPR courses and patient experiences, there isn't anything that I could suggest which you don't already know. I wish that I could offer more but at least I am listening and have empathy!

Tell me a joke, laughter is the best medicine and if I can't get my patients to at least smile I am not doing my job. 

 

Rod

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Rod, it seems pretty clear that your are having allergic reaction to something in the environment where you are working.  It would seem prudent to see a dermatologist in the area who would be familiar with local conditions, maybe someone with admitting privileges to the hospital where you are working.   I am not sure why you are so hesitant to see someone in the local area.  

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Have you evaluated your soap? Do you use any lotion? The only lotion I can use without a reaction is Nivea original. For soap I only use Ivory liquid. Since your condition flared up as soon as you started washing your hands again I would certainly look into that.

Linda

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Have I missed you saying at least in general where this is occurring?  I know one place I go causes me some mostly minor issues. It took me a while to figure it  out but once I did I could control it pretty easy most of the time.  It was in very low humidity and lots of dust.   Plenty of pollen too but I believe it to be mostly the dryness and dust. I hope someone can help you find an answer.

As for venting, you are preaching to the choir.  I personally have a love/hate relationship with the VA.

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